Posterior circulation hypoperfusion plays an important role in refractory otalgia: case report

This case explored the association among posterior circulation hypoperfusion, cryptogenic vertebral artery dissection (CVAD), and idiopathic intractable otalgia. A 67-year-old male patient, afflicted with recurrent right otalgia for over 50 years and misdiagnosed with otitis and trigeminal neuralgia, demonstrated posterior circulation hypoperfusion on cerebral CT perfusion imaging. Conventional vascular tests turned up nothing, yet dynamic contrast-enhanced CT (DCE-CT) disclosed a long-segment CVAD with endothelial flaps within the intracranial vertebral artery, precisely matching the hypoperfused territory. Post endovascular stent repair of the CVAD, the hypoperfusion normalized and the otalgia vanished. At 29 months, the patient remained pain - free without analgesics.This case highlights that CVAD-related posterior circulation hypoperfusion is a critical contributor to cryptogenic intractable otalgia. The evidence supports the efficacy of endovascular therapy as a promising intervention.